Let the right one in: High admission rate for low-acuity pediatric burns

Anderson, Kathryn T.; Bartz-Kurycki, Marisa A.; Garwood, Grant M.; Martin, Robert; Gutierrez, Rigoberto; Supak, Dylan N.; Wythe, Stephanie N.; Kawaguchi, Akemi L.; Austin, Mary T.; Huzar, Todd F; Tsao, KuoJen

doi:10.1016/j.surg.2018.06.046

Cited by 5 publications

(1 citation statement)

References 22 publications

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“… 10 , 11 Interestingly, Anderson et al found that although most pediatric patients presenting to their institution with burn injuries were low acuity, a majority were admitted, and social factors and transfer status were more strongly associated with admission than burn size or mechanism. 12 In light of these factors, the documented inconsistency of non-burn center clinician’s evaluation of burns, and the lack of randomized control studies, an expert panel devised updated guidelines in 2020. 13 – 16 Perhaps the most important message from this update is the reframing of the ABA criteria as “consultation guidelines.” There do not otherwise appear to be substantive changes regarding more specific disposition recommendations for pediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Burns – Who Requires Follow-up? A Study of Urban Pediatric Emergency Department Patients

Heyming,

Dunkelman,

Gibbs

et al. 2024

Western Journal of Emergency Medicine

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Introduction: Hundreds of children suffer burn injuries each day, yet care guidelines regarding the need for acute inpatient treatment vs outpatient follow-up vs no required follow-up remain nebulous. This gap in the literature is particularly salient for the emergency clinician, who must be able to rapidly determine appropriate disposition. Methods: This was a retrospective review of patients presenting to a Level II pediatric trauma center, January 1, 2017–December 31, 2019, and discharged with an International Classification of Diseases, Rev 10, burn diagnosis. We obtained and analyzed demographics, burn characteristics, and follow-up data using univariate and bivariate analysis as well as logistic regression modeling. Patients were stratified into three outcome groups: group 1—patients who underwent emergent evaluation at a burn center or were admitted at their first follow-up appointment; group 2—patients who followed up at a burn center (as an outpatient) or at the emergency department (and were discharged home); and group 3—patients with no known follow-up. Results: A total of 572 patients were included in this study; 58.9% of patients were 1–5 years of age. Sixty-five patients met group 1 criteria, 189 patients met group 2 criteria, and 318 patients met group 3 criteria. Sixty-five percent of patients met at least one American Burn Association criteria, and 79% of all burns were second-degree burns. Flame and scald burns were associated with increased odds (odds ratio [OR] 1.21,O1.12) of group 1 vs group 2 + group 3 (P = 0.02, P < 0.001). Second/third-degree burns and concern for non-accidental trauma were also associated with increased odds of group 1 vs 2 or 3 (OR = 1.11, 1.35, P ≤ 0.001, 0.001, respectively). Scald burns were associated with increased odds of group 2 compared to group 3 (OR 1.11, P = 0.04). Second/third degree burns were also associated with increased odds of group 2 vs 3 (OR 1.19, P ≤ 0.001). Conclusion: There were few statistically significant variables strongly associated with group 1 (emergent treatment/admission) vs group 2 (follow-up/outpatient treatment) vs group 3 (no follow- up). However, one notable finding in this study was the association of scald burns with treatment (admission or follow-up) suggesting that the presence of a scald burn in a child may signify to clinicians that a burn center consult is warranted.

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